Background: Healthcare tourism is an emerging economy with the most potential in China's health industry before the COVID-19 pandemic. Surgical medical health tourism accounts for a large part of medical tourism services in China, which has higher requirements for quality and safety. By contrast, measurement tools and theoretical research are insufficient in China. The aim of this study was to develop a set of reliable and feasible indicators by augmenting the original Donabedian’s quality model to evaluate surgical tourism services’ quality.
Methods: Literature review and focus group interview were used to generate indicators for surgical tourism services’ quality. The basic framework of the evaluation system was based on the structure-process-outcome Donabedian model. The screening and weight setting were conducted through analytic hierarchy process (AHP) and a two-round Delphi consultation with 13 panelists. Validity and reliability of experts were tested by the experts' positive coefficient, authority coefficient, and coordination coefficient. Reliability of the questionnaire was assessed by a pretest distributed within an international medical department of a public hospital in China.
Results: Based on the Donabedian’s quality theory, the novel evaluation system of surgical tourism service institutions with 3 dimensions, 9 first-level items and 39 second-level items was constructed. The three dimensions consist of structure (0.315), process (0.287), and outcome (0.398), with each dimension set several indicators and each indicator given a weight. Of the two rounds of Delphi consultation, the response rates were 86.67% and 100%. The coordination coefficient of expert opinions in the two rounds of consultation were 0.49 and 0.65 (p<0.05). For the empirical study, the self-evaluation score of a public hospital was 86, which could obtain a rating of two stars.
Conclusions: The established evaluation system identified three different dimensions of surgical tourism services’ quality which fit for practical healthcare improvement in safety and quality. It can reflect the access criterion of surgical tourism institutions, provide references on better choices of surgical services for tourists, and can be applied by healthcare managers and policy makers to allocate resources more efficiently and promote more surgical tourism services to international standards.